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Soaring drug deaths turn focus on anti-overdose drug

By Alyssa Botelho

Naloxone can save lives, but easier access is politically contentious

(Image: AP/PA/Mel Evans)

In 1992 Tracey Helton, a long-time heroin addict, shot up. Only this time was different&colon; she had been clean for a month and her body couldn’t handle the opiate surge. The overdose would have killed her, she says, had she not been brought back from the dead by a drug that researchers call miraculous, but that the public largely hasn’t heard of. With overdose deaths on the rise, campaigners are calling for it to be supplied more widely as a potential lifesaver.

Naloxone, sold under various trade names including Narcan, could prove to be a game changer in stemming an alarming rise in deaths from prescription opiates and heroin in the US and the UK. Naloxone has long been stocked in ambulances and emergency rooms in both countries, but making it available to those who often are first on the scene of an overdose – the police and the drug-taker’s friends and family – is proving controversial. Some argue having such a “safety net” could make drug users more reckless, and some efforts to pass laws to distribute naloxone more widely have stalled.

One such opponent is Paul LePage, the governor of Maine. In June last year he vetoed a bill that would have expanded access to naloxone in the state, justifying his stance on the grounds that the drug “would make it easier for those with substance abuse problems to push themselves to the edge, or beyond”.

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Worst “flu” ever

Addiction researcher Alexander Walley of Boston University says this argument does not tally with reality. Given via injection or nasal spray, naloxone binds powerfully with opiate receptors in the brain, repelling the drugs the user has taken and sending him or her into an instant and painful withdrawal. He says it’s akin to “the worst flu of one’s life”, accompanied by sweats and chills, vomiting and aches. Helton, who has not taken heroin for 16 years, agrees.

“A person who has received naloxone never wants to have that experience again,” she says. “You could go up to an addict overdosing on the street and say you’ll give them naloxone, and they’ll try to get up and walk away.”

With deaths due to prescription opiates and heroin overdoses skyrocketing – the US figure has quadrupled since 1999, to more than 16,000 in 2010 – legislators are taking heed. Seventeen US states already have laws expanding naloxone access to loved ones and first responders. And last month both Ohio and Wisconsin state legislatures passed similar bills that are now waiting to be signed into law. In the UK, naloxone has since 2005 been on a list of injection drugs that the general public can administer for lifesaving purposes.

What’s missing, says John Strang, an addiction researcher at King’s College London, is solid science to back up anecdotal findings and policy decisions. Strang is leading a massive study, called N-ALIVE, that will be the largest ever to test if take-home naloxone can effectively prevent overdose deaths.

Prisoner trials

“One in 200 people coming out of prison with a history of heroin use are dead within a month,” Strang says. The overdose risk spikes more than sevenfold during that month-long window, he explains, because users who may once have become numbed to opiates regain their sensitivity while clean in jail. He has partnered with 16 prisons in the UK, and hopes to recruit 56,000 prisoners over five years into the trial.

Half of the prisoners, selected at random, will continue to be given standard prison pamphlets that explain the risk of post-release overdose. The other half will be given an “emergency kit” that includes a single dose naloxone-loaded syringe and a training DVD to watch with loved ones. Twelve weeks after release, researchers will cross-check reported overdose deaths with the identities of trial participants.

So far, the team has recruited 1000 prisoners into their pilot study, which will report preliminary results once the 5600 subjects have gone through the program.

If smaller studies are anything to go by, Strang has good reason to be optimistic. In 2003, the San Francisco Department of Health tried distributing naloxone to drug users and their loved ones through needle exchange programs. Heroin overdose deaths dropped from roughly 160 a year to 70 and has hovered in the single digits since 2009, says Phillip Coffin, who directs the city’s substance abuse research program. And in the Boston suburb of Quincy, where the police have carried naloxone nasal sprays for three years, Lieutenant Detective Patrick Glynn says officers have reversed the effects of every one of 226 heroin overdoses they encountered.